Liu Yaodan, Liu Min, Liu Jinghua, Sheng Minmin, Hu Zhenxia, Zhang Xiaohong
Department of Gynecology and Obstetrics, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Department of Pharmacy, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Front Med (Lausanne). 2024 Aug 22;11:1441085. doi: 10.3389/fmed.2024.1441085. eCollection 2024.
Intrahepatic cholestasis of pregnancy (ICP) and gestational diabetes mellitus (GDM) are two common pregnancy complications that pose considerable health challenges. The interplay between these conditions is believed to significantly influence pregnancy outcomes, yet the nature of this relationship remains elusive. This study was designed to elucidate the connection between ICP and GDM.
This retrospective cohort study included 742 singleton pregnancies delivered at the Shanghai Public Health Clinical Center from January 2015 to December 2023. We compared the incidence of GDM and pregnancy outcomes between multiple ICP subgroups and a control group of healthy pregnancies. A multivariate regression model was used to measure the independent association between ICP and propensity for GDM development, as well as to assess the impact of potential bidirectional effects between ICP and GDM.
The results indicate that the incidence of GDM is highest in the early-onset ICP (diagnosed before the 24th week of gestation) group compared to the control group and other ICP subgroups. Early-onset ICP is an independent risk factor for the development of GDM, with other risk factors including age, history of abortion, family history of diabetes, and elevated ALT levels. Subgroup interaction analysis did not reveal heterogeneity in the influence of early-onset ICP on the development of GDM across different subgroups. Further analysis showed that GDM itself does not increase the risk of late-onset ICP. Additionally, when comparing pregnancy outcomes between GDM patients with or without ICP, those with both GDM and ICP had significantly higher rates of preterm birth, cesarean section, and small for gestational age (SGA) compared to patients with GDM alone. Furthermore, elevated TBA levels (first diagnosed) of early-onset ICP patients were associated with an increased risk of GDM in a nonlinear fashion.
Our study indicated that early-onset ICP is significantly linked to an increased risk of GDM. Further research is warranted to explore the mechanisms behind this association and to develop strategies for early identification and intervention to mitigate GDM risk.
妊娠期肝内胆汁淤积症（ICP）和妊娠期糖尿病（GDM）是两种常见的妊娠并发症，对健康构成了相当大的挑战。人们认为这些情况之间的相互作用会显著影响妊娠结局，然而这种关系的本质仍然难以捉摸。本研究旨在阐明ICP与GDM之间的联系。
这项回顾性队列研究纳入了2015年1月至2023年12月在上海公共卫生临床中心分娩的742例单胎妊娠。我们比较了多个ICP亚组与健康妊娠对照组之间GDM的发病率和妊娠结局。使用多变量回归模型来衡量ICP与GDM发生倾向之间的独立关联，并评估ICP与GDM之间潜在双向效应的影响。
结果表明，与对照组和其他ICP亚组相比，早发型ICP（妊娠24周前诊断）组中GDM的发病率最高。早发型ICP是GDM发生的独立危险因素，其他危险因素包括年龄、流产史、糖尿病家族史和ALT水平升高。亚组交互分析未发现早发型ICP对不同亚组GDM发生影响的异质性。进一步分析表明，GDM本身不会增加晚发型ICP的风险。此外，在比较有或没有ICP的GDM患者的妊娠结局时，与仅患有GDM的患者相比，同时患有GDM和ICP的患者早产、剖宫产和小于胎龄儿（SGA）的发生率显著更高。此外，早发型ICP患者首次诊断时升高的总胆汁酸（TBA）水平与GDM风险增加呈非线性相关。
我们的研究表明，早发型ICP与GDM风险增加显著相关。有必要进一步研究以探索这种关联背后的机制，并制定早期识别和干预策略以降低GDM风险。
